• Scope

• The 2.7-mm scope is most frequently used and is our preference.

▪ The 2.7-mm scope is ideal for the ankle and allows anterior ankle arthroscopy as well as intraarticular evaluation. Furthermore, the 2.7-mm scope can be safely used for posterior ankle arthroscopy, subtalar arthroscopy, and tendoscopy.

▪ Occasionally, the 1.9-mm scope is used in tight ankles and pediatric cases.

▪ Some advocate the use of the 4.0-mm scope, which can be useful in anterior ankle arthroscopy but can pose a challenge for intra-articular evaluation.¹

• The 30-degree scope is adequate in most situations; however, a 70-degree scope is useful for viewing the posterior joint from anterior portals.

• Standard arthroscopy tower

▪ Monitor, light source, shaver motor, printer.

▪ We do not routinely use an arthroscopic pump for fluid inflow, instead we rely on gravity flow from 3-L saline bags.

• Intra-articular instruments (Fig. 61-1)

▪ Commercially available sets designed for ankle arthroscopy incorporate smaller instruments to facilitate safe intra-articular work. These sets generally include the following:

• Probes

• Basket forceps in a variety of sizes and angles

○ Useful for creating a “leading edge” in thickened soft tissue or scar tissue that can then be debrided with a motorized shaver. Also useful for the debridement of loose cartilage flaps.

▪ Graspers

• For removal of loose bodies or debris created from the debridement of osteochondral defects.

▪ Curettes in a variety of sizes and angles

• For debridement of osteochondral defects.

▪ Microfracture picks in a variety of angles

▪ Osteotomes

• Useful for removal of impinging osteophytes or for removal of cartilage in arthroscopic ankle arthrodesis.

▪ Motorized instruments

• Shavers: Generally a 2.5-mm full-radius shaver is used, although a 3.5-mm shaver can be used as needed.

• Burrs: 3.0-5.0-mm round burr is useful for debridement of anterior osteophytes or debridement for arthroscopic ankle arthrodesis.

• Supine

• Unlike most foot and ankle procedures, the patient’s heels are not positioned at the end of the table to accommodate the space required for the noninvasive distraction device. Another option is to use a table rail extender.

• Thigh holder

• Places the hip in approximately 45 degrees of flexion while the knee is in ˜90 degrees of flexion. The proper position allows the heel to gently touch the OR table. We are careful to position the thigh holder proximal to the popliteal fossa to decrease pressure on the vessels in the posterior knee (Fig. 61-2).

• Noninvasive distractor (Fig. 61-3)

• Noninvasive ankle distraction improves access to the ankle joint.

• It is important, however, to limit the time distraction is used to decrease both postoperative neurapraxia and compression of the terminal nerve branches at the midfoot.2,3

• Joint distraction can decrease access to the anterior compartment and can be removed during debridement deep to the anterior capsule.¹

• As demonstrated in Figure 61-4, the distractor can pull the talus anteriorly and paradoxically decrease access to the ankle joint in unstable ankles. We have found that unstable ankles can often be approached without the use of a distractor.

• Tourniquet

• A thigh tourniquet can be used at the discretion of the surgeon.